Sláintecare Implementation Strategy & Action Plan 2021 — 2023

Objectives

Sláintecare seeks to establish a universal, single-tier health and social care system in which access is equitable, determined by clinical need rather than ability to pay, and supported by safe, high-quality, patient-centred services.[1][2]The 2021–2023 Strategic Action Plan translates this vision into two Reform Programmes: improving safe, timely access to care and promoting health and wellbeing; and addressing health inequalities on the path towards universal healthcare.[3][4]

• Deliver care as close to people’s homes as safely possible, shift appropriate activity from acute hospitals to community settings, and preserve hospital capacity for those with greatest need.[5][6]
• Improve timely access by expanding capacity, improving patient flow and productivity, redesigning referral and care pathways, developing elective capacity in Dublin, Cork and Galway, and reducing hospital and community waiting lists.[7][8][9]
• Work towards maximum waiting times of 12 weeks for inpatient procedures, 10 weeks for outpatient appointments, 10 days for diagnostic tests and four hours in emergency departments.[7]
• Strengthen prevention, public health and healthy living through physical activity, healthy eating, smoking cessation, alcohol-harm reduction, mental health, screening, social prescribing and settings-based initiatives.[10][11]
• Expand integrated community care through Community Healthcare Networks, specialist hubs, chronic disease management, frailty and reablement services, virtual wards, community diagnostics, home supports and services for vulnerable groups.[6][12]
• Advance public-only care in public hospitals through the Sláintecare Consultant Contract and removal of private care from public hospitals.[5][9]
• Develop a Citizen Care Masterplan that uses population profiling, segmentation and needs assessment to plan services, workforce, capital infrastructure, eligibility and funding around population need.[13][14]
• Address inequalities through the Sláintecare Healthy Communities Programme, six Regional Health Areas and implementation of A Healthy Weight for Ireland: Obesity Policy and Action Plan 2016–2025.[15][4]

Implementation

Implementation combines eleven projects, national workstreams and cross-government action, led by the Sláintecare Programme Implementation Office within the Department of Health.[3][16]Delivery builds on Health Service Capacity Review 2018 recommendations, COVID-19 learning, increased investment in staffing and infrastructure, and coordinated work by the Department of Health, Health Service Executive, government departments, community organisations, voluntary and private providers, professional bodies, staff and the public.[2][17][18]

• Operate Healthy Living, Enhanced Community Care and Hospital Productivity workstreams to integrate prevention, community services, hospital reform and care-pathway redesign.[5][10]
• Establish Community Healthcare Networks as the foundation for locally integrated care, with a plan for 96 networks and recruitment of up to 7,000 community-based staff; implementation activity also includes rollout through 57 networks and 18 specialist hubs.[6][9]
• Scale successful Integration Innovation Fund projects, using evaluation, mainstream funding, audit-informed improvement and the Integration Innovation Learning Network to spread effective models.[6][8]
• Implement digital enablers including electronic prescribing, remote consultations, electronic discharge, shared care records, clinical decision support, national waiting-list systems, patient-management systems and digital public signposting.[9][12]
• Prepare infrastructure and elective-centre projects through business cases, planning applications, fire certification, tendering and construction processes, subject to Government decisions and the Public Spending Code.[8][12]
• Develop a Population-Based Resource Allocation Funding Model linking resource allocation to assessed health need, potentially through Regional Health Areas, and review universal eligibility, entitlement, financial mechanisms and phasing for Government decision.[13][14]
• Deliver Healthy Communities through national and local structures, initially providing health-specific interventions in 18 of 51 Social Inclusion and Community Activation Programme areas in 2021, with further rollout dependent on funding and learning.[15]
• Strengthen workforce planning through end-to-end staffing models, consultation with professional and education bodies, recruitment and retention measures, and alignment of training with population needs and service redesign.[15]
• Manage delivery through named project leads, project plans, Project Initiation Documents, critical paths, milestone dates and RAID logs for risks, actions, issues and dependencies.[19]
• Report progress regularly to the Cabinet Committee on Health and the Joint Oireachtas Committee on Health, while the Sláintecare Programme Implementation Office coordinates oversight, periodic public updates and a review after the first full implementation year.[2][19][18]
• Monitor outcomes through the Healthy Ireland Outcomes Framework, Health Service Capacity Review reporting framework, Health System Performance Assessment framework, waiting-list reporting, project evaluations and population-segmentation measures.[10][13][18]
• Support accountability through the Health Service Executive Board, Regional Health Areas, the Patient Safety Office, governance structures, stakeholder forums and project-level ownership.[3][20]

Monitoring & Evaluation

Monitoring combines programme oversight, performance frameworks, project controls and selected service indicators. The Sláintecare Programme Implementation Office monitors implementation, reports periodically through public update reports, and coordinates oversight with the Department of Health, the Health Service Executive and other stakeholders.[18]Progress has also been reported to the Cabinet Committee on Health and the Joint Oireachtas Committee on Health.[2]

• Apply the Health System Performance Assessment framework for Ireland, the Health Service Capacity Review 2018 reporting framework and the Healthy Ireland Outcomes Framework to assess system performance, supply-side investment, health and wellbeing outcomes, and prevention activity.[18][10]
• Monitor waiting-list reduction through a multi-annual plan, periodic reporting, identification of waiting lists across care settings and disciplines, and accountable programme governance.[5][9][21]
• Track implementation and impacts of integration innovations, including mainstreamed or scaled projects, through evaluation and the Integration Innovation Learning Network.[6][21][22]
• Use audit-informed and research-driven improvement projects, care pathways and decision-support tools to support incident prevention, productivity, coordination, timeliness and outcomes.[8]
• Monitor Healthy Communities implementation through baseline measures, implementation metrics and future outcome measures, including measures for population segments and service redesign.[23]
• Strengthen accountability through named project leads, Project Initiation Documents, milestone dates, risk, action, issue and dependency logs, regular reporting, the HSE Board and Regional Health Areas.[19][20]

Selected quantified indicators include maximum target waits of 12 weeks for inpatient procedures, 10 weeks for outpatient appointments, 10 days for diagnostic tests and four hours in emergency departments.[7]Capacity indicators include 321 funded critical care beds, approximately 11,699 acute inpatient beds, 1,250 community, repurposed rehabilitation and sub-acute beds, and approximately 135 sub-acute beds.[24]The plan also identifies 24.26 million funded home-support hours and approximately 136,000 additional general practitioner diagnostic tests.[24]

Evidence and learning mechanisms include research on COVID-19 service changes, implementation webinars, patient-experience surveys, obesity surveillance sources and the planned review of the Strategic Action Plan after its first full implementation year.[20][25][26][19]However, a consolidated indicator set, common reporting timetable, detailed surveillance arrangements, independent evaluation methodology and independent accountability framework for the full plan are not specified.[9][11][4]

Costing & Financing

Budget 2021 provides a Sláintecare reform allocation of €1.235 billion, including €136 million in capital funding, to expand capacity, community and social care, access initiatives, national strategies and digital health.[27]The funding supports delivery of the 2021 Reform Programmes, including staffing, infrastructure, additional beds, community services and targeted access measures.[28]

• Allocate €467 million to increased acute and community bed capacity in 2021.[24]
• Allocate €150 million to Enhanced Community Services in 2021, alongside a stated total investment of €186 million for 2020–2021.[24]
• Allocate €133 million to social care expansion, €25 million to general practitioner access to diagnostics and €5 million to community paramedicine, critical-care retrieval, Pathfinder and the 1813 Medical Helpline.[24]
• Allocate €15 million to health and wellbeing, €90 million to additional disability services and €23 million to mental healthcare expansion.[27]
• Allocate €33 million in eHealth revenue funding and €95 million in eHealth capital funding.[27]
• Allocate €121 million to implementation of national strategies and expert reviews, and €78 million to improving access to care.[27]

Resource planning also includes a proposed Population-Based Resource Allocation Funding Model, intended to link allocations to assessed population health need and encourage care in the appropriate setting.[13]A funding framework is to be developed and costed using existing activity and expenditure by population segment, for approval to inform the National Service Plan 2022.[23]Capital planning, workforce planning and universal eligibility work are expected to consider financial mechanisms and phasing.[13][14]

Other identified funding mechanisms include Integration Innovation Fund Round 2, mainstream funding for successful Round 1 projects from 2021 onwards, National Service Plan funding for Enhanced Community Care staffing, Healthy Ireland-funded initiatives, and targeted and protected funding identified through project documentation.[5][6][15][19]Rollout of Healthy Communities beyond the initial 18 Social Inclusion and Community Activation Programme areas is subject to funding.[15]Programme-level budgets for most actions, detailed funding sources, funding gaps, cost methods and economic assumptions are not specified.[29][14][27]